Sultana Saima, Bruinsma Fiona, Fisher Zeshi, Homer Caroline S E, Vogel Joshua P
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Women's, Children's and Adolescents' Health Program, Burnet Institute, Melbourne, Australia.
PLOS Glob Public Health. 2025 May 7;5(5):e0004575. doi: 10.1371/journal.pgph.0004575. eCollection 2025.
Antenatal corticosteroids (ACS) is a critical preterm birth intervention that reduces neonatal mortality and short-term morbidities when administered to women at risk of preterm birth <34 weeks' gestation. While numerous systematic reviews have evaluated the effects of ACS on child health outcomes, this body of evidence has not been comprehensively assessed. This overview of systematic reviews thus aimed to comprehensively summarize the findings on the effects of ACS for preterm birth on long-term outcomes in children. We searched six electronic databases, with no date and language restrictions. Systematic reviews of randomized, non-randomized trials or observational studies that evaluated childhood health outcomes (assessed at age 12 months or older) for any ACS exposure compared to no ACS exposure, including comparisons between different types and regimens of ACS were eligible. We used the AMSTAR-2 tool to assess the quality of the included reviews. We included 19 systematic reviews. We identified a wide range of outcomes across the included reviews and categorized them as neurodevelopmental, psychological, physical growth, respiratory, cardiovascular, and survival/mortality outcomes. The reported outcomes were substantially varied in terms of operational definitions, terminology, timing of assessment, and measurement. No benefits or harms were observed for most of the reported outcomes following ACS exposure, though many outcomes had few participants. Available evidence suggested that a single course of ACS possibly has positive effects on selected neurodevelopmental outcomes. However, ACS exposure might also have adverse effects on psychological and some neurodevelopmental outcome in children born at late preterm or at term. Heterogeneity in outcome measurements and reporting, including overall confidence in results, contributes to uncertainties about long-term effect of ACS and warrants caution while interpreting the findings. Further high-quality research is required to generate robust evidence base on the effects of ACS on long-term child health outcomes.
产前使用糖皮质激素（ACS）是一项关键的早产干预措施，对于妊娠小于34周有早产风险的孕妇，使用该措施可降低新生儿死亡率和短期发病率。虽然已有大量系统评价评估了ACS对儿童健康结局的影响，但尚未对这一证据体系进行全面评估。因此，本系统评价概述旨在全面总结关于早产时使用ACS对儿童长期结局影响的研究结果。我们检索了六个电子数据库，没有日期和语言限制。纳入的系统评价需为随机、非随机试验或观察性研究，这些研究评估了任何ACS暴露与未暴露相比对儿童健康结局（在12个月及以上年龄评估）的影响，包括不同类型和方案的ACS之间的比较。我们使用AMSTAR-2工具评估纳入评价的质量。我们纳入了19项系统评价。我们在纳入的评价中确定了广泛的结局，并将其分类为神经发育、心理、身体生长、呼吸、心血管以及生存/死亡结局。所报告的结局在操作定义、术语、评估时间和测量方面存在很大差异。在ACS暴露后，大多数报告的结局未观察到有益或有害影响，不过许多结局的参与者较少。现有证据表明，单疗程ACS可能对选定的神经发育结局有积极影响。然而，ACS暴露也可能对晚期早产或足月出生儿童的心理和一些神经发育结局产生不利影响。结局测量和报告的异质性，包括对结果的总体信心，导致了关于ACS长期影响的不确定性，在解释研究结果时需要谨慎。需要进一步开展高质量研究，以生成关于ACS对儿童长期健康结局影响的可靠证据基础。
